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*IT PERMIT APPLICATIO
<br /> BUILDING ECHANICAL/ PLUMBING /SIGN
<br /> INKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue orBlack,Ink Only'Please) PROJECT SITE INFORMATION I* ,` aVA
<br /> PROJECT SITE ADDRESS:615 58th Street SE, Everett, WA 98203 PROPERTY TAX#:00471700000502
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> \!;AB-.,, ,.,,CONTACT 1 1FORMATiO;N?- , „ ,, xw ,;:. #Ski ,. r
<br /> OWNER NAME: Richard Pidgeon TENANT BUSINESS NAME(Commercial):
<br /> OWNER MAILING ADDRESS: STREET615 58th Street SE
<br /> crry Everett STATE WA zip 98203
<br /> OWNER PHONE: (425) 438-1197 OWNER EMAIL:archer05@frontier.com
<br /> CONTRACTOR NAME: Matvey Foundation Repair
<br /> CONTRACTOR ADDRESS: STREET 1912 S 146th St
<br /> ciTy Seatac STATE WA ZIP 98148
<br /> CONTRACTOR PHONE:(253) 327-1650 CONTRACTOR EMAIL:permits@gomatvey.com
<br /> CONTRACTOR LICENSE#(REQUIRED):Matvefr837k5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 056264
<br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:(253) 680-9200
<br /> Tara Todd CONTACT EMAIL:permits@gomatvey.com
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<br /> BUILDING INFO�tM - '�
<br /> Existing Use of Building:Single Family Residence Contract Price of Work:$13,915
<br /> Proposed Use of Building:No change Heat Source: ❑Gas DElectric ❑Other
<br /> BUILDING USE: OSFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ❑Commercial ❑Accessory Structure
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑✓Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: Underpinning of the existing single family residence to stabilize the foundation.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): n/a
<br /> ., 1MECHANICAL;PERMIT,APPLICATION„ .' PLUIVIBiNG PERMIT APPLICATION,,
<br /> Fixture Fixture Fixture Fixture
<br /> Count List of Fixtures count List of Fixtures Count List of Fixtures Count List of Fixtures
<br /> A/C—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo
<br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor)
<br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet
<br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures
<br /> Gas Fireplace/Insert/Log Roof Drains Water Heater
<br /> SPRINKLER.!SUPPRESSION SYSTEM,, Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System No.of Heads
<br /> Chemical Suppression System No.of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with
<br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the State ontracto a aw 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
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<br /> PERMIT ISI ���
<br /> Tara Todd Digitally s,9�ed by Tara Todd
<br /> DOwner/Authori'e Agent Signaturede 2os.a3.z2 ssz:n mo° Date (Revised
<br /> (Revised 10/10/2018)
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